Benign esophageal lesions: endoscopic and pathologic features

Abstract

Benign esophageal lesions have a wide spectrum of clinical and pathologic features. Understanding the endoscopic and pathologic features of esophageal lesions is essential for their detection, differential diagnosis, and management. The purpose of this review is to provide updated features that may help physicians to appropriately manage these esophageal lesions. The endoscopic features of 2997 patients are reviewed. In epithelial lesions, the frequency of occurrence was in the following order: glycogenic acanthosis, heterotopic gastric mucosa, squamous papilloma, hyperplastic polyp, ectopic sebaceous gland and xanthoma. In subepithelial lesions, the order was as follows: hemangioma, leiomyoma, dysphagia aortica and granular cell tumor. Most benign esophageal lesions can be diagnosed according to their endoscopic appearance and findings on routine biopsy, and submucosal lesions, by endoscopic resection. Management is generally based upon the confidence of diagnosis and whether the lesion causes symptoms. We suggest endoscopic resection of all granular cell tumors and squamous papillomas because, while rare, these lesions have malignant potential. Dysphagia aortica should be considered in the differential diagnosis of dysphagia in the elderly.

Keywords: Benign tumor; Endoscopy; Epithelial lesions; Esophagus; Subepithelial lesions.

Figure 1

Heterotopic gastric mucosa. A: Heterotopic gastric mucosa appears salmon-colored under conventional endoscopy and is recognized as flat or slightly elevated; B: Narrow band imaging facilitates mucosal surface evaluation of heterotopic gastric mucosa by adjusting reflected light to enhance the contrast between the esophageal mucosa and the gastric mucosa and may improve the diagnosis of heterotopic gastric mucosa.

Figure 2

Squamous cell papilloma. A: Squamous cell papilloma is recognized as whitish-pink, wart-like exophytic projections on conventional endoscopy; B: Narrow band imaging facilitates mucosal surface evaluation of squamous cell papilloma and shows that microvessels in the lesion are not dilated.

Figure 3

Hyperplasia polyp. Hyperplasia polyp occurs as a polypoid lesion and is located on edematous inflamed gastric folds at the gastroesophageal junction.

Figure 4

Xanthoma. Xanthomas are endoscopically recognized as elevated, granular, yellowish, fern-like lesions and scattered on a normal mucosal surface.

Figure 5

Ectopic sebaceous gland. A: The number of ectopic sebaceous gland is variable from single to B: more than one hundred yellowish plaques measuring 1 to 2 mm in the esophagus.

Figure 6

Glycogenic acanthosis. A: Esophagogastroduodenoscopy reveals multiple, uniformly sized, oval or round glycogenic acanthosis usually < 1 cm, involving otherwise normal esophageal mucosa; B: In chromoscopy with iodine spray, glycogenic acanthosis is recognized as slightly elevated iodine-positive, brownish areas.

Figure 7

Leiomyoma. A: Leiomyoma commonly arises from the muscularis propria layer of the esophagus and presents as submucosal tumor; B: Leiomyoma arising from the muscularis mucosae can present as a polypoid intraluminal tumor.

Figure 8

Granular cell tumor. A: Granular cell tumor is endoscopically recognized as a firm, yellowish subepithelial tumor covered with the normal mucosa in the esophagus; B: Endoscopic ultrasonography of granular cell tumor shows a homogenous hypo-echogenic tumor extending from the muscularis mucosa layer, and the musculais propria is not involved.

Figure 9

Hemangioma. On endoscopy, esophageal hemangioma appears cystic and bluish-red and can be pressed with biopsy forceps.

Figure 10

Dysphagia aortica. A: Esophagogastroduodenoscopy reveals a pulsatile extrinsic compression at about 25 cm from the incisor; B: The chest computed tomography showed aortic arch and descending aorta tortuosity with compression into adjacent esophagus. The arrow indicates the esophagus.